Endovascular assisted removal of intrapelvic lag screw after intramedullary proximal femoral nail: A case report and literature review.

Background: Trochanteric fractures are very common hip injuries often fixed with intramedullary nailing as the recommended treatment. Medial lag screw migration of the intramedullary nail system is an uncommon complication. The objective of this case report is to highlight the importance of optimal reduction in hip fractures and the need for a multidisciplinary approach with vascular assistance in intrapelvic lag screw migration. Case report and results: We collected 24 cases of intrapelvic migration of the lag screw in the latest literature. Here, we report the case of a 68-year-old patient with medial pelvic migration of the lag screw after minor trauma and its removal using peroperative simultaneous angiography. After removal of the osteosynthesis material, a revision to a total hip arthroplasty was performed. Conclusion/discussion: This is the first case demonstrating an endovascular assisted removal simultaneous with revision surgery. We suggest that a multidisciplinary approach is warranted in which the orthopedic surgeon is assisted by a vascular surgeon. An endovascular assisted open removal of the lag screw with conversion to a hip arthroplasty is considered a safe treatment.

Evaluation of the role of povidone­iodine in the prevention of surgical site infections.

Background: The occurrence of surgical site infections (SSIs) is associated with increased risk of mortality, development of other infections, and the need for reintervention, posing a significant health burden. The aim of this review was to examine the current data and guidelines around the use of antiseptic povidone­iodine (PVP-I) for the prevention of SSIs at each stage of surgical intervention. Methods: A literature search for selected key words was performed using PubMed. Additional papers were identified based on author expertise. Results: Scientific evidence demonstrates that PVP-I can be used at every stage of surgical intervention: preoperative, intraoperative, and postoperative. PVP-I is one of the most widely used antiseptics on healthy skin and mucous membranes for preoperative surgical site preparation and is associated with a low SSI rate. For intraoperative irrigation, aqueous PVP-I is the recommended agent and has been demonstrated to decrease SSIs in a range of surgical settings, and for postoperative wound healing, there is a growing body of evidence to support the use of PVP-I. Conclusions: There is a need for more stringent study designs in clinical trials to enable meaningful comparisons between antiseptic agents, particularly for preoperative skin preparation. The use of a single agent (PVP-I) at each stage of surgical intervention could potentially provide advantages, including economic benefits, over agents that can only be used at discrete stages of the surgical procedure. Key message: Evidence supports the use of PVP-I at all stages of surgical intervention, from preoperative measures (including skin preparation, preoperative washing, and nasal decolonization) to intraoperative irrigation, through to postoperative wound management. However, there is a need for more stringent study designs in clinical trials to enable meaningful comparisons between antiseptic agents, particularly for preoperative skin preparation.

Total Hip Arthroplasty with Cemented Dual Mobility Cup into a Fully Porous Multihole Cup with Variable Angle Locking Screws for Acetabular Fractures in the Frail Elderly.

Purpose: The purpose was to examine the clinical and radiological outcomes after surgical treatment of acetabular fractures with total hip arthroplasty with a dual mobility cup cemented into a porous multihole cup in the population of frail elderly patients. Materials and Methods: A retrospective review of 16 patients who underwent surgery (mean age, 76.7 years) with a mean follow-up period of 36.9 months was conducted. Following surgery, patients underwent postoperative follow-up at six weeks, three, six, and 12 months and clinical and radiological examinations were performed. Results: Classification of fractures was based on the Letournel classification. Following surgery, all patients were allowed weight-bearing as tolerated immediately postoperative. Fourteen patients showed maintenance of preoperative mobility status at one year. The mean Harris hip score was 64.8 (range, 34.7-82.8) and 80.0 (range, 60.8-93.8) at three months and one year, respectively. The mortality rate was 12.5% at one year (2/16). Complications included heterotopic ossification (2/16), deep venous thrombosis (1/16), heamatoma (1/16), and femoral revision due to a Vancouver B2 fracture (1/16). No case of deep infection, dislocation, or implant loosening was reported. Conclusion: Total hip arthroplasty using a dual mobility cup cemented into a porous multihole cup with locking screws resulted in a stable construct with a capacity for immediate weight-bearing as tolerated with rapid relief of pain. The findings of this study suggest that this procedure can be regarded as a safe method that has shown promising clinical and radiological outcomes for treatment of patients with medical frailty.

Conservative treatment of knee osteoarthritis.

Osteoarthritis of the knee causes chronic knee pain, loss of function and disability in the ageing population. When no treatment is applied, a guaranteed onset of symptoms and/or structural damage can be observed in the diseased knee. This work reviewed the different published guidelines, proposing combinations of weight reduction, physical therapy and rehabilitation, self-management education programs and pharmacological treatment. Randomized clinical trials, systematic reviews and guidelines were identified using the databases PubMed and Web of Science. Specific journals and reference lists were investigated. Sixty high quality articles were included concerning the conservative treatment of knee osteoarthritis. Weight loss when BMI > 28kg/m 2 ; aerobic, proprioception and strengthening training; NSAIDs (ibuprofen, diclofenac, aceclofenac), IA corticosteroid and IA hyaluronic acid has the highest evidence. To achieve the greatest positive clinical and structural outcome, a combined conservative therapy is recommended.

Internal fixation of an intertrochanteric femoral fracture after Birmingham hip resurfacing arthroplasty.

The Birmingham hip system is one of the most popular designs for hip resurfacing. Fractures associated with the Birmingham Hip Resurfacing (BHR) are mostly subcapital fractures. Other traumatic periprosthetic fractures are rarely reported. We report an intertrochanteric fracture which occurred after a Birmingham hip resurfacing. The fracture was treated with a reversed distal femoral locking plate, with a very satisfying clinical and radiological result.

Successful laparoscopic exploration and screw extraction for intractable pain after anterior iliosacral arthrodesis.

We report on the case of a patient suffering from L5 radicular pain after previous anterior sacroiliac arthrodesis using 2, 4-hole plates. Technical investigations indicated loosening and migration of a screw from the upper sacroiliac plate, irritating the L5 nerve root. The problem was managed by removal of the screw using an anterior transperitoneal laparoscopic approach.

Endoscopically assisted core decompression in avascular necrosis of the femoral head.

The authors have used bone endoscopy (medulloscopy) to improve the accuracy of the conventional technique for core decompression and grafting in 36 hips with avascular necrosis of the femoral head. Endocopy was found to facilitate debridement of the necrotic bone and to decrease the risk of perforation of the cartilage during debridement. The endoscopy-assisted technique failed, however, to improve the final outcome of core decompression and grafting in more advanced stages of osteonecrosis. Based on this experience, the authors do not recommend core decompression, with or without endoscopic assistance, in advanced stages of avascular necrosis, but they suggest using endoscopic assistance during decompression in small-size lesions.

Does harvesting of iliac bone grafts with an acetabular reamer reduce complication rate?

Autogenous bone grafts are often used in orthopaedic surgery. One of the well-known techniques to obtain the grafts from either the anterior superior or posterior iliac spine uses a classic acetabular reamer. This retrospective study searches for the frequency of complications and discomfort in a population of 78 patients after this kind of bone graft harvesting. Data were collected by means of mail questionnaires. All possible major and minor complications such as haematomas, infections, pain and sensory alterations were investigated. We had no major complications. We only found minor sensory and pain complications. We were able to procure large amounts of cancellous bone graft through this method. This method of cancellous grafting reduces the rate of major complications, but there is no difference in the occurrence of postoperative pain as compared with standard techniques. The minor sensory complications are comparable with other methods of iliac spine harvesting. When performing iliac spine bone harvesting procedures,good knowledge of the nerve anatomy is of prominent importance.

The "susper" lesion, a specific entity in open calcaneal fractures.

The limited soft tissue covering makes the treatment of open calcaneal fractures especially difficult. The most important objectives in open fracture management are to avoid infection, to obtain fracture healing and to restore function. Low-velocity open fractures with a medial skin split, the so-called "susper" lesions, represent a distinct fracture group in which standard operative treatment is not contra-indicated. The medial skin split is caused by the sustentaculum fragment which perforates the medial skin during landing on the everted and externally rotated heel.